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Acta Neurochirurgica

, Volume 88, Issue 3–4, pp 79–86 | Cite as

Resistance to cerebrospinal fluid outflow and intracranial pressure in patients with hydrocephales after subarachnoid haemorrhage

  • F. Gjerris
  • S. E. Børgesen
  • P. S. Sørensen
  • F. Boesen
  • K. Schmidt
  • A. Harmsen
  • J. Lester
Article

Summary

Resistance to CSF-outflow (Rout) and intracranial pressure (ICP) were measured in 33 patients with hydrocephalus after subarachnoid haemorrhage (SAH). Eleven patients examined between 10 to 30 days after SAH had high pressure hydrocephalus (HPH). Twenty-two patients had normal pressure hydrocephalus (NPH). All HPH-patients had ICP above 15 mmHg, plateau waves and B-waves, a median Rout of 59 mmHg×ml−1×min−1 (range 29–100). All NPH-patients had a normal ICP level, no plateau waves, but long periods of B-waves and a median Rout of 22 mmHg×ml−1×min−1 (range 6–47).

Of the 11 patients with HPH six were shunted and five had temporary ventricular drainage. Five patients improved and six died. Of the five survivors only one went back to work. Of the 22 NPH-patients 18 were treated with a shunt, one refused shuntoperation and three had normal Rout. Seventeen improved after shunting. At followup 12 had a normal social life, 5 lived in a nursing home and 1 was dead.

Thus, early development of hydrocephalus after subarachnoid haemorrhage is associated with a high Rout and a high ICP, whereas late (more than one month) hydrocephalus may be associated with normal ICP and high Rout. Patients with NPH and a high Rout have frequent B-waves and should be shunted. Patients with a long interval from subarachnoid haemorrhage to the diagnosis of hydrocephalus often have a normal ICP, low frequency of B-waves, normal CSF-dynamics and need no shunting.

Keywords

Subarachnoid haemorrhage resistance to CSF-outflow conductance to CSF-outflow CSF-dynamics intracranial pressure high pressure hydrocephalus normal pressure hydrocephalus CT-scanning 

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References

  1. 1.
    Adams HP, Kassell NF, Torner JC, Sahs AL (1983) CT and clinical correlations in recent aneurysmal subarachnoid hemorrhage: a preliminary report of the cooperative aneurysm study. Neurology 33: 981–988PubMedGoogle Scholar
  2. 2.
    Auer LM, Sayama I (1983) Intracranial pressure oscillations (Bwaves) caused by oscillations in cerebrovascular volume. Acta Neurochir (Wien) 68: 93–100Google Scholar
  3. 3.
    Black PM, Tzouras A, Foley L (1985) Cerebrospinal fluid dynamics and hydrocephalus after experimental subarachnoid hemorrhage. Neurosurg 17: 57–62Google Scholar
  4. 4.
    Blasberg R, Johnson D, Fenstermacher J (1981) Absorption resistance of cerebrospinal fluid after subarachnoid hemorrhage in the monkey; effect of heparin. Neurosurg 9: 686–691Google Scholar
  5. 5.
    Brock M, Furuse M, Hasuo M, Dietz H (1975) Influence of CSF-resorption pathways on intracranial capacitance. Adv Neurosurg 3: 109–113Google Scholar
  6. 6.
    Børgesen SE (1984) Conductance to outflow of CSF in normal pressure hydrocephalus. Acta Neurochir (Wien) 71: 1–41CrossRefGoogle Scholar
  7. 7.
    Børgesen SE, Gjerris F (1982) The predictive value of conductance to outflow of CSF in normal pressure hydrocephalus. Brain 105: 65–86PubMedGoogle Scholar
  8. 8.
    Børgesen SE, Gjerris F (1987) The relationship between intracranial pressure, ventricular size and resistance to CSF outflow. J Neurosurg; in pressGoogle Scholar
  9. 9.
    Børgesen SE, Gjerris F, Sørensen SC (1978) The resistance to cerebrospinal fluid absorption in humans. Acta Neurol Scand 56: 88–96Google Scholar
  10. 10.
    Børgesen SE, Westergaard L, Gjerris F (1981) Isotope cisternography and conductance to outflow of CSF in normal pressure hydrocephalus. Acta Neurochir (Wien) 57: 67–73Google Scholar
  11. 11.
    Conner ES, Foley L, Black PM (1984) Experimental normalpressure hydrocephalus is accompanied by increased transmantle pressure. J Neurosurg 61: 322–327PubMedGoogle Scholar
  12. 12.
    Doczi T, Ambrose J, O'Laoire S (1984) Significance of contrast enhancement in cranial computerized tomography after subarachnoid hemorrhage. J Neurosurg 60: 335–342PubMedGoogle Scholar
  13. 13.
    Ekstedt J (1977) CSF hydrodynamic studies in man. I. Method of constant pressure CSF infusion. J Neurol Neurosurg Psychiatry 40: 105–119PubMedGoogle Scholar
  14. 14.
    Fuhrmeister U, Ruether P, Dommasch D, Gaab M (1980) Alterations of CSF hydrodynamics following meningitis and SAH. In: Shulman K et al (eds) Intracranial pressure IV. Springer, Berlin Heidelberg New York, pp 241–244Google Scholar
  15. 15.
    Gjerris F, Børgesen SE, Hoppe E, Boesen F, Nordenbo AM (1982) The conductance to outflow of CSF in adults with high-pressure hydrocephalus. Acta Neurochir (Wien) 64: 59–67Google Scholar
  16. 16.
    Gonzalez-Darder J, Barbera J, Cerda-Nicolas M, Segura D, Barcia-Salorio JL (1984) Sequential morphological and functional changes in kaolin-induced hydrocephalus. J Neurosurg 61: 918–924PubMedGoogle Scholar
  17. 17.
    Hakim S, Venegas JG, Burton JD (1976) The physics of the cranial cavity, hydrocephalus: Mechanical and normal pressure hydrocephalus: Mechanical interpretation and mathematical model. Surg Neurol 5: 187–210PubMedGoogle Scholar
  18. 18.
    Hansen K, Gjerris F, Sørensen PS (1987) Absence of hydrocephalus in spite of impaired cerebrospinal fluid absorption and severe intracranial hypertension. Acta Neurochir (Wien) 86: 93–97.Google Scholar
  19. 19.
    Hayashi M, Kobayashi H, Kawano H, Handa Y, Yamamoto S, Kitano T (1985) ICP patterns and isotope cisternography in patients with communicating hydrocephalus following rupture of intracranial aneurysm. J Neurosurg 62: 220–226PubMedGoogle Scholar
  20. 20.
    Hildebrandt G, Werner M, Kaps M, Busse O (1985) Acute noncommunicating hydrocephalus after spontaneous subarachnoid haemorrhage. Acta Neurochir (Wien) 76: 58–61Google Scholar
  21. 21.
    Ishii M, Suzuki S, Julow J (1979) Subarachnoid haemorrhage and communication hydrocephalus. Scanning electron microscopic observations. Acta Neurochir (Wien) 50: 265–272Google Scholar
  22. 22.
    Kosteljanetz M (1984) CSF dynamics in patients with subarachnoid and/or intraventricular hemorrhage. J Neurosurg 60: 940–946PubMedGoogle Scholar
  23. 23.
    Lundberg N (1960) Continuous recording and control of ventricular pressure in neurosurgical practice. Acta Psychiat Scand 36: [Suppl 149] 1–193Google Scholar
  24. 24.
    Murata T, Handa H, Mori K, Nakano Y (1981) The significance of periventricular lucency on computed tomography: Experimental study with canine hydrocephalus. Neuroradiology 20: 221–227PubMedGoogle Scholar
  25. 25.
    Penn RD, Bacus JW (1984) The brain as a sponge: a computed tomographic look at Hakim's hypothesis. Neurosurg 14: 670–675Google Scholar
  26. 26.
    Rosenberg GA, Saland L, Kyner WT (1983) Pathophysiology of periventricular tissue changes with raised CSF pressure in cats. J Neurosurg 59: 606–611PubMedGoogle Scholar
  27. 27.
    Sundbärg G, Pontén U (1976) ICP and CSF absorption impairment after subarachnoid hemorrhage. In: Beks JWF et al (eds) Intracranial pressure III. Berlin Heidelberg New York, Springer pp 139–146Google Scholar
  28. 28.
    Tapaninaho A, Hernesniemi J, Vapalahti M (1983) Intraventricular pressure after aneurysm operations. In: Ishii S et al (eds) Intracranial pressure V. Springer, Berlin Heidelberg New York, pp 709–715Google Scholar
  29. 29.
    Vapalahti M, Nieminen V, Kari K (1976) Incidence of hydrocephalus and increased ventricular fluid pressure in patients with ruptured supratentorial aneurysms. In: Beks JWF et al (eds) Intracranial pressure III. Springer, Berlin Heidelberg New York, pp 135–138Google Scholar
  30. 30.
    Vassilouthis J (1984) The syndrome of normal-pressure hydrocephalus. J Neurosurg 61: 501–509PubMedGoogle Scholar
  31. 31.
    Vassilouthis J, Richardson AE (1979) Ventricular dilatation and communication hydrocephalus following spontaneous subarachnoid hemorrhage. J Neurosurg 51: 341–351PubMedGoogle Scholar
  32. 32.
    Voldby B (1986) Ruptured intracranial aneurysm. A clinical and pathophysiological study. Dan Med Bull 33: 53–64PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1987

Authors and Affiliations

  • F. Gjerris
    • 1
  • S. E. Børgesen
    • 3
  • P. S. Sørensen
    • 1
  • F. Boesen
    • 1
  • K. Schmidt
    • 3
  • A. Harmsen
    • 1
  • J. Lester
    • 2
  1. 1.University Clinics of NeurosurgeryRigshospitalet
  2. 2.University Clinics of NeuroradiologyRigshospitalet
  3. 3.University Clinic of NeurosurgeryCopenhagen County HospitalGlostrupDenmark

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